Geriatric Functional Rating Scale (GFRS)

Does the patient have any dietary restrictions?

Is the person's judgment impaired?

Does the patient have auditory or visual hallucinations?

Can the person read and write letters?

Is the person able to use the telephone?

Is the person able to bank and shop?

Is the person able to prepare simple meals and bake?

Can the person dress and wash self without assistance?

Can the person use public transportation?

Is the person able to take his or her own medications and follow a diet?

Is the patient ethnically compatible with the community?

Are helpful friends, relatives, neighbors, etc. available?

Is the person able to shop at a reliable grocery that delivers when necessary?

Is a club or center geared to the aged available?

Is a supportive church or synagogue available?

Is a library available?

Are other shopping and recreational facilities available?

Are public health nurses available?

Are Meals-on-Wheels or similar services available?

Are homemaker services accessible?

Are friendly visitors available?

Are medical facilities accessible?

Is public transportation accessible?

Are the person's living quarters readily accessible?

Eyesight

Hearing

Mobility

Cardiopulmonary function

Disorientation

Delusions

Memory loss

Energy and drive

Relatives and friends

Financial situation